Chronic Fatigue, Stalled Gym Progess, Hormone or Lifestyle Issue?

-age: 31
-height: 6’2"
-waist: 34.5"
-weight: 200
-bf: guessing between 16%-18%

-describe body and facial hair: Coarse dark beard, fairly hairy legs and arms, chest and stomach hair as well. Receding hairline

-describe where you carry fat and how changed: always had been thin, noticed 3-4 years ago started carrying a majority of fat around midsection. Started lifting at least 3x week Aug '12

-health conditions, symptoms [history]: developed allergies in 20s, started immunotherapy ~ 4 years ago. Had surgery to correct a deviated septum. Started trying to combat chronic fatigue at the same time that all started. Did a pulse oximeter test fall '13 but doc said readings were normal and I did not need a sleep study. Snore and often wake up not being able to breath through nose in the morning. Average 7 hrs of sleep a night. Wake up feeling tired but seems like I couldn’t sleep in if I tried. Most days at work have brain fog, get home and have no motivation or energy to do anything. 2 weeks ago while doing a hard squat set I gave myself a primary exertion headache, just had an MRI done yesterday to ensure its not a secondary exertion headache. Still suffering with the aftereffects of that such as dizziness and getting winded easily. Blood pressure was 118/78 when I saw the doc about it. Partially tore labrum of left rotator cuff about 7 years ago, doesn’t bother me enough to warrant surgery. Joint pain in my left knee, squats and stretching 3x week are about the only things it has responded well to.

Have dry skin, knuckles crack and bleed all winter long. Even with using lotion and wearing gloves during sleep.

QOL depends on day, bad days I feel borderline depressed, or just apathetic to doing anything. Do not handle stress well, disrupts my day to the point where I cannot do anything productive or even fun (video games, watch a movie) until the source of stress has been removed. Good days I’m fine, but feels like its way too easy to be overwhelmed.

Saw on a different thread, before starting treatment of allergies/sinuses used to often get sinus infections/tonsilloliths. Is now down to 2-3 times a year rather than monthly. Still get uncomfortable sinus pressure in spring/fall.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Tried Flonase for a few months, think it was helping my sinuses but stopped recently due to worries of potential side effects. Still on immunotherapy for allergies. Started using Rogain on hairline 1.5 months ago. *Appears to have helped and should have started using much earlier. Have tried several supplements, usually take fish oil, creatine, and vitamin d. Recently tried l-theanine which seems to help with brain fog but not fatigue. Have tried many different supplements but none consistently. The last week I have been adding a multivitamin to my lunches. After reading the forums picked up iodorol which I’ve been taking EOD, only have an ear thermometer which in the morning shows 98.4 in one ear and 97.9 in the other ear - need to get a better thermometer.

-lab results with ranges
All bloods were done by Labcorp Dublin

8/23/13 10:53 AM
T Total LC/MS 576.2 ng/dL range: 348.0 - 1197.0
Free T (direct) 12.4 pg/mL range: 8.7 - 25.1

3/19/14 9:05 AM
T Total LC/MS 660.2 ng/dL range: 348.0 - 1197.0
Free T (direct) 14.3 pg/mL range: 8.7 - 25.1

3/31/14 8:35AM *read the suggested labs right after getting my test check on the 19th which is why this is a week later, also blood draw was both 2.5 days after suffering an exertion headache in the gym and 12 hours post orgasm.

TSH 3.650 uIU/mL range 0.450 - 4.500
T4 8.3 ug/dL range 4.5 - 12.0
T3 Uptake 41 % HIGH range 24 - 39
fT4 Index 3.4 range 1.2 - 4.9
DHT 44 ng/dL Ref Range Adult Make: 30 - 85
T4 free (direct) 1.55 ng/dL range 0.82 - 1.77
LH 6.1 mIU/mL range 1.7 - 8.6
FSH, Serum 3.7 mIU/mL range 1.5 - 12.4
Prolactin 11.4 ng/mL range 4.0 - 15.2
*12 hours post orgasm, did not see tip about 48 hour suggestion
Estradiol 15.2 pg/mL range 7.6 - 42.6
Roche ECLIA methodology
PSA, Serum <0.1 ng/mL range 0.0 - 4.0
Roche ECLIA methodology
Triiodothyronine, Free, Serum 3.6 pg/mL range 2.0 - 4.4

4/22/14
Cortisol saliva test
7:30AM 7.8 ng/mL range 3.7 - 9.5 (morning)
1:20PM 2.6 ng/mL range 1.2 - 3.0 (noon)
6:08PM 1.9 ng/mL range .6 - 1.9 (evening)
midnight 1.5 ng/mL range .4 - 1.0 (night)

4/26/14 8:21AM Labcorp Dublin

DHEA-Sulfate 404.1 ug/dL range 138.5 - 475.2
Prolactin 12.0 ng/mL range 4.0 - 15.2
Estradiol 20.9 pg/mL range 7.6 - 42.6
PSA Serum .5 ng/mL range 0.0 - 4.0
IGF-1 138 ng/mL range 88 - 246 *labcorp Burlington
rT3 Serum 20.6 ng/dL range 9.2 - 24.1 *labcorp burlington
SHBG Serum 39.6 nmol/L range 16.5 - 55.9

-describe diet [some create substantial damage with starvation diets]
Dairy heavy diet. Definitely eat too much sugar. Ranges from 2200-3500 calories depending on day. Lunch is typically greek yogurt, cheese stick, carrot, banana, protein bar, sandwich, can of pop, and chips. When cutting or eating healthier I make silverhydra’s meat slop. Typically have 4-6 beers in a given week.
Drink decaf coffee at work but have 1-2 energy drinks as they are free at the cafeteria.

-describe training [some ruin their hormones by over training]
Aug '12 did starting strength 3 days a week, stalled early around the 5 month mark with 160lb bench, 225 squat, and 260 DL maxes. Was doing a bulk and went from 180 lbs to 207 lbs by Jan '13. Switched to a cut with greyskull lp, dropped back down to 185 by Aug '13 but leaner than before. Now doing 5/3/1 BBB with a Tue/Wed/Thur/Fri split. Bench is now around 185, squat 245, deadlift 375ish. Gains seem slow, cannot keep up with monthly adding 5 lbs to lifts on 5/3/1, have to do bi-monthly or tri-monthly adding weight to lifts. Typically spend 1 hr in the gym, during the school year I do a martial arts class at a local college Monday night and Saturday mornings for 3 hours. Off in the summers. Have a desk job so I sit a lot, try to do a 10 min walk during lunch.

-testes ache, ever, with a fever?
Testes don’t typically ache with or without fever.

-how have morning wood and nocturnal erections changed
Get morning wood less than once a month, been that way for so long cannot remember when it started happening less. Sex drive is ok, but many nights too tired to even attempt. Bigger problem is delayed ejaculation, no issue getting hard but have trouble finishing and usually go soft midway through sex.

Tempted to try self-administered TRT and see if it makes any difference. Have access to any supplies needed to do so.

Wellness screening blood draw from 8/6/13 Lab: SBMF Ref Ranges: CHP

Test | result | range | unit

  1. WBC 6.03 | 4 - 10.8 | x10E3/uL
  2. Basophils 0.5 | 0 - 1 | %
  3. Lymphocytes 27.9 | 23 - 44 | %
  4. Monocytes 8.8 | 4 - 13 | %
  5. Neutrophils 61 | 37 - 77 | x10E3/mL
  6. RBC 4.81 | 4.1 - 6 | x10E6/uL
  7. Hemoglobin 14.2 | 12.5 - 18 | g/dL
  8. Hematocrit 43.8 | 36 - 55 | %
  9. MCV 91.1 | 80 - 98 | fL
    10.MCH 29.5 | 27 - 34 | pg
    11.MCHC 32.4 | 32 - 36 | g/dL
    12.RDW 13.4 | 11.7 - 15 | %
    13.Platelet Count 188 | 140 - 415 | x10E3/uL
    14.Total Cholesterol 169 | 100 - 199 | mg/dL
    15.HDL Cholesterol 51 | 40 - 120 | mg/dL
    16.LDL Cholesterol 104 | 0 - 129 | mg/dL
    17.Total/HDL Ratio 3.3 | 0 - 5 | ratio
    18.LDL/HDL Ratio 2.04 | 0.75 - 3.6 | ratio
    19.Triglycerides 71 | 0 - 149 | mg/dL
    20.Glucose 89 | 65 - 99 | mg/dL
    21.Hemoglobin A1C 5.3 | 4.8 - 5.8 | %
    22.BUN 15 | 5 - 26 | mg/dL
    23.Creatinine 1.08 | 0.76 - 1.27 | mg/dL
    24.Total Protein 7.1 | 6 - 8.5 | g/dL
    25.Albumin 4.8 | 3.5 - 5.5 | g/dL
    26.Globulin 2.3 | 2.2 - 3.7 | g/dL
    27.ALB/GLO 2.1 | 1.1 - 2.5 | g/dL
    28.eGFR > 60 | 59 - 155 | ml/min/1.73m^2
    29.Total Bilirubin 0.5 | 0.1 - 1.2 | mg/dL
    30.Alkaline Phosphatase 59 | 25 - 150 | IU/L
    31.GGT 22 | 0 - 65 | IU/L
    32.AST (SGOT) 27 | 0 - 40 | IU/L
    33.ALT (GPT) 18 | 0 - 55 | IU/L
    34.Sodium 142 | 135 - 147 | mmol/L
    35.Potassium 4.3 | 3.5 - 5.2 | mmol/L
    36.Chloride 104 | 97 - 108 | mmol/L
    37.Calcium 9.9 | 8.5 - 10.6 | mg/dL
    38.TSH 2.19 | 0.35 - 5.5 | mU/L
    39.C-Reactive Protein (CRP) 0.62 | 0 - 2.89 | mg/L
    40.Homocysteine 7.3 | 1 - 12.99 | mg/L
    41.Vitamin D 48 | 30 - 100 | ng/mL
    42.Ferritin 72 | 40 - 600 | mcg/L
    43.H Pylori 35.1 | 0 - 30 *treated with 1wk triple therapy
    44.Insulin 3 | 0 - 18

Not sure most of this is any help, but had some blood cell counts, cholesterol, and vitamin D details.

TSH over 2 can be worth looking into, but the rest of your thyroid levels look ok. MIght want to read KSman’s stuff on iodine replacement.

I would get a 4x saliva test for cortisol. I get them from canary club. You should also check DHEA-s via blood.

Re-read KSman’s iodine stuff. Yesterday started Iodoral loading, 4x 12.5mg spread throughout the day.
New oral thermometer came in the mail. Temp’s I’ve recorded so far
4/14
6:47PM 98.1
4/15
1AM 98.0
7:00AM 98.1
1:40PM 98.3
4/16
3:30PM 98.2

Temps look pretty good actually. I would do the 4x saliva test for cortisol and a blood draw for DHEA-s.

[quote]dhickey wrote:
Temps look pretty good actually. I would do the 4x saliva test for cortisol and a blood draw for DHEA-s.[/quote]

I second this. dhickey recommended this test for me 6-9 months ago and I waited until my doctor thought it was a good idea to. I would have found out earlier my cortisol was about a quarter the range had I done it myself.

Mine was insanely low too. Figuring that out and doing something about it are two quite different things. I really struggled to get it back in a range that would allow me to function. I really didn’t want to go on HC. Pretty sure it’s still less than optimal, but it’s not slowing me down much anymore.

jaggar, what did you do to address your issues?

I had ordered the cortisol test, it should arrive on Friday. The nearest labcorp blood draw location is an hour drive from my house, and everything is paid for out of pocket. The next time I go I will do the DHEA-s test, might wait till I get one or two other tests I’ll want to run at the same time.

Labcorp is about an hour from me as well. You could just take some DHEA. It’s almost always less than optimal, especially if you suspect adrenal issues. You could try 25mg of micronized DHEA per day and test after a few weeks.

I’ll order some DHEA from Amazon, doesn’t look too expensive. UPS got delayed so I haven’t received my cortisol test yet. Hopefully can do that tomorrow. Starting to lean toward this being a poor sleep issue again, GP claims my overnight pulse oximeter study was normal but I’ve started using breathe right strips at night when I remember to.

Snoring is reduced (not eliminated) and since then there has been an increase in morning wood. Wondering if I may have a sub-clinical case of obstructive sleep apnea. Scheduled a meeting with my ENT for next week to discuss.

make sure the DHEA is micronized. Looking into sleep issues is an excellent idea. A sleep study can be pretty expensive, but worth it if you can identify and solve issues there. Was kind of a waste of time for me. They made me sleep on my back for the study and I never sleep on my back. All the events they flagged were when I was on my back. No events when I did roll to my side. Just a warning if you’re not a back sleeper.

[quote]dhickey wrote:
Mine was insanely low too. Figuring that out and doing something about it are two quite different things. I really struggled to get it back in a range that would allow me to function. I really didn’t want to go on HC. Pretty sure it’s still less than optimal, but it’s not slowing me down much anymore.

jaggar, what did you do to address your issues?[/quote]

Actually, I haven’t done anything yet. My treatment is still in it’s infancy. Right now I’m taking adrenal function supplements for what thats worth. Doc wanted to try that first before HC. How did you get yours up?

[quote]jaggar wrote:

[quote]dhickey wrote:
Mine was insanely low too. Figuring that out and doing something about it are two quite different things. I really struggled to get it back in a range that would allow me to function. I really didn’t want to go on HC. Pretty sure it’s still less than optimal, but it’s not slowing me down much anymore.

jaggar, what did you do to address your issues?[/quote]

Actually, I haven’t done anything yet. My treatment is still in it’s infancy. Right now I’m taking adrenal function supplements for what thats worth. Doc wanted to try that first before HC. How did you get yours up?[/quote]

Not sure where it’s at now. Much better I assume. Not really sure what “fixed” it. Did some of the things in the the linked article. Seemed to help, but still felt like I was walking a tight rope. A little bit of stress, a few nights of shitty sleep, and/or pushing too hard in the gym would send me right back down. Licorice root might have stimulated me a little too much if I remember correctly, which means it probably works pretty well.
http://www.T-Nation.com/free_online_article/sports_body_training_performance_nutrition/the_truth_about_adrenal_fatigue

LEF has some good suggestions too.

I don’t really take anything specifically for adrenal insufficiency. I went on TRT, which I’m now trying to come off in some form. I focused on quality sleep, which was a pain in the ass to sort out. I also focused on stress reduction, cleaned up my diet a bit and accepted that I couldn’t push too hard in the gym.

Added the DHEA-S lab, and redid the Prolactin and PSA following the proper protocols to my first post. Should have Cortisol results in the next day or two.

Apparently I fall asleep on my side but I’m told once I’m asleep I roll to my back and start snoring. Saw an ENT this afternoon, said for my age my tonsils are a +3 in size and also have an elongated uvula. He thought the best next step would be a sleep study to definitively see if I have OSA.

Cortisol samples were collected on 4/22
7:30AM 7.8 ng/mL range 3.7 - 9.5 (morning)
1:20PM 2.6 ng/mL range 1.2 - 3.0 (noon)
6:08PM 1.9 ng/mL range .6 - 1.9 (evening)
midnight 1.5 ng/mL range .4 - 1.0 (night)

not sure if it would have any effect, but I did burn my mouth on pizza at 2pm on the day I did the cortisol saliva test.

That doesn’t look terrible. Ideally you’d want to be at the top of the range in the morning and then towards the lower part of the range at night.

If you’re having sleep issues, just take care of that. Everything else should fall in line to some degree. You’ll just be chasing your tail until that’s taken care of. If it’s not apnea, there are a ton of supplements you can try to improve sleep. I’ve tried most of them. Z-12 is really good stuff. Might want to try ZMA first, as that has other benefits. I’m a hard case, so I graduated past those. Time release Melatonin helps quite a bit for me, along with my prescription and some peptides.

Just got my results back from my sleep study. I have 16 sleep interruptions per hour, which wikipedia says 15-30 is moderate severity. They want to start me on a cpap, though I want to look into surgery for removing my tonsils as I hate the thought of having to live with a machine. I hate having things near my nose/eyes.

Being as impatient as I am, for the last two weeks I have been doing a self-administered TRT protocol as prescribed in the beginners guide which has reduced almost all of my fatigue and mental fog.

The CPAP isn’t that bad if you sleep on your back. I roll from side to side, so it didn’t work out for me. My insurance required a rental for x number of months before they would pay for the full purchase. That’s kind of nice if you’re not sure it will work. I just had to pay for the hose and mask when I brought it back.

When I first started TRT, I got pretty significant relief from my fatigue issues. Don’t be surprised if it creeps back a little once your body adjusts. Hopefully taking care of your sleep issues fixes that.

EGA,

If you want your life back, read this book, then call the guy.

Best $12 you’ll ever spend.

kaynon311@gmail.com if you want to discuss whatever.